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Several studies showed some protections by certain individual dietary antioxidants against CRC development. Epidemiologic data on the composite dietary antioxidant index (CDAI) in relation to CRC risk are sparse. Using the Singapore Chinese Health Study, an ongoing prospective cohort consisting of 61\u2009321 cancer\u2010free participants aged 45 to 74\u2009years at baseline, a food\u2010based CDAI was calculated according to a previously established and validated method that included six food\u2010sourced antioxidants including vitamins A, C and E, manganese, selenium and zinc. Cox proportional hazard regression method was used to estimate the hazard ratios (HRs) and their 95% confidence intervals (CIs) for CRC associated with various levels of CDAI with adjustment for multiple potential confounders. After an average of 17.5\u2009years of follow\u2010up, 2140 participants developed CRC. HRs (95% CIs) of CRC for quartiles 2, 3 and 4 of CDAI were 0.94 (0.83\u20101.07), 0.86 (0.75\u20101.00) and 0.80 (0.66\u20100.98), respectively, compared to the lowest quartile (<jats:italic>P<\/jats:italic><jats:sub>trend<\/jats:sub>\u00a0=\u2009.02). This inverse association between CDAI and CRC risk was more apparent in women or those without a history of diabetes, without family history of CRC, never smokers or overweight\/obese individuals. However, none of the heterogeneity tests for the CDAI\u2010CRC risk association reached statistical significance. Our findings suggest that food\u2010based antioxidants may be beneficial for reducing the risk of CRC in the general population.<\/jats:p>","DOI":"10.1002\/ijc.33925","type":"journal-article","created":{"date-parts":[[2022,1,10]],"date-time":"2022-01-10T05:49:33Z","timestamp":1641793773000},"page":"1599-1608","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":143,"title":["Composite dietary antioxidant index and the risk of colorectal cancer: Findings from the Singapore Chinese Health Study"],"prefix":"10.1002","volume":"150","author":[{"given":"Yi\u2010Chuan","family":"Yu","sequence":"first","affiliation":[{"name":"University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center Pittsburgh  Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedram","family":"Paragomi","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center Pittsburgh  Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renwei","family":"Wang","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center Pittsburgh  Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aizhen","family":"Jin","sequence":"additional","affiliation":[{"name":"Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine National University of Singapore  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Schoen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Graduate School of Public Health University of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li\u2010Ting","family":"Sheng","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College Huazhong University of Science and Technology  Wuhan Hubei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"An","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College Huazhong University of Science and Technology  Wuhan Hubei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woon\u2010Puay","family":"Koh","sequence":"additional","affiliation":[{"name":"Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine National University of Singapore  Singapore"},{"name":"Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR)  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4620-3108","authenticated-orcid":false,"given":"Jian\u2010Min","family":"Yuan","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center Pittsburgh  Pennsylvania USA"},{"name":"Department of Epidemiology, Graduate School of Public Health University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2172-1849","authenticated-orcid":false,"given":"Hung N.","family":"Luu","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center Pittsburgh  Pennsylvania USA"},{"name":"Department of Epidemiology, Graduate School of Public Health University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,1,18]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32319-0"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2015-310912"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/jjco\/hys230"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.65"},{"key":"e_1_2_10_7_1","unstructured":"World Cancer Research Fund International\/American Institute for Cancer Research.Continuous Update Project Report: Diet Nutrition Physical Activity and Colorectal Cancer.https:\/\/www.wcrf.org\/sites\/default\/files\/Colorectal-cancer-report.pdf. 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